Healthcare Provider Details

I. General information

NPI: 1174633903
Provider Name (Legal Business Name): KATHRYN ELISE CALABRIA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 STEWART AVE SUITE 1ES
GARDEN CITY NY
11530-4892
US

IV. Provider business mailing address

2797 MONTAUK HWY
BROOKHAVEN NY
11719-9596
US

V. Phone/Fax

Practice location:
  • Phone: 631-776-0432
  • Fax: 516-227-5373
Mailing address:
  • Phone: 631-776-0432
  • Fax: 631-803-6064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberA169270
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: